Medical Procedure

Here’s a difference (OK, another difference) between my wife and me: When my wife has a minor “procedure” (read colonoscopy) and is instructed not to drink any alcohol for the rest of the day of the procedure, she doesn’t. She has coffee to keep her awake through the afternoon, and then water with dinner. When I have the same procedure and am instructed not to drink any alcohol for the day of the procedure, I’m having a beer within minutes of my getting home from the procedure and a glass of wine (or two) with dinner that night. Actually, the day before the procedure, I cut the horrific syrup that’s meant to ream your bowels with vodka (despite the non-alcohol admonition in the instructions). My wife’s thinking is – as I suspect many people’s thinking is – that you should follow the instructions of your health professionals. My thinking is that my health professionals are covering their legal butts. If they don’t caution you against doing just about anything – wearing jewelry, driving, drinking alcohol, eating fatty foods, watching reality TV – then they could be charged with malpractice if your body or mind should react in some unfortunate if unlikely way. I don’t buy it. I understand it from an insurance point of view. But insurance is a scam meant only to make money for the insurance companies. So I’m not wont to follow medical instructions that derive from the threat of law suits. I’m comfortable knocking back a PBR and watching Dancing With the Stars.

My Colonoscopy

My discharge instructions include: YOU SHOULD HAVE A REPEAT COLONOSCOPY IN 10 YEARS. That’s not likely to happen. It might, should I have some specific reason to have it done. But I’m not going to do it just because that’s what our goliath healthcare industry deems a good thing to do. My doctor first suggested I have a colonoscopy 12 years ago, when I turned 50. That’s the age when all men are supposed to undergo the procedure. I had my doubts. I wasn’t all that concerned, as many men apparently are, about having a roto rooter shoved up my butt. I knew I’d be sedated, and besides, I’ve been through much more painful procedures (sinus and knee replacement surgery come to mind, as do hemorrhoid surgery and a vasectomy). I was more anxious about the day before, when you have to drink 32 ounces of a foul concoction (sodium sulfate, potassium sulfate, and magnesium sulfate), followed by more than twice as much water, and then sit on the toilet as everything in your body that isn’t attached goes shooting like a fire hose into the commode. Oh, and you can’t have any solid food that day, only clear liquids (vodka’s a clear liquid, isn’t it?). Actually, that day went all right; it was uncomfortable, a hassle, but there were no embarrassing accidents or any of the side effects listed on the expunging solution package (seizures and death struck me as most worrisome; vomiting, nausea, bloating, and dizziness seemed almost tame). It was the morning of the procedure that turned out to be the worst part of the experience. The purging of my body of solids and liquids the day before had left me dehydrated and weak. I’d slept nine hours. My mouth was dry, but I wasn’t supposed to drink anything. I took a shower, shakily making my way down the stairs, but had to lie on the bed for a few minutes afterward to regain some strength. Walking into the hospital, I felt like the old man I guess I am. The procedure itself was routine; I was another widget on a colonoscopy conveyor belt (my doctor was doing nine that morning). Everything went smoothly. There was no pain, no real discomfort. Thankfully, when it was over, the nurses gave me three cans of orange juice, and that, combined with the IV that had been stuck in me for an hour, helped with both my dehydration and strength. The doctor deemed me “very healthy,” and I left the hospital for a late, large breakfast of scrambled eggs, hash browns, ham, an English muffin, and two cups of very welcomed coffee – the first solid food I’d had in 40 hours.

So if the whole process went pretty much as I’d expected, without problem or pain, why would I balk at doing it again in 10 years? Aren’t I relieved to know that I don’t have colon cancer? (That’s the rationalization for the majority of us who go through the procedure in the clear.)

Well, I pretty much knew going in that I didn’t have colon cancer. I’m relatively healthy. I eat well. I exercise regularly. I have no history of colon cancer on either side of my family. I’m all for preventive medicine. I go to the dentist twice a year. I see my eye doctor once a year. I go to my dermatologist at least once a year. But I go regularly to my dentist, my eye doctor, and my dermatologist because I have a history of tooth, eye, and skin problems (including skin cancer). Also, all of those visits probably wouldn’t add up in ten years to what this colonoscopy is going to cost (my insurance company, not me). Our health care system is one of the most sophisticated, technologically advanced in the world. But the working philosophy seems to be, use it if you’ve got it. We test because we can. But I’ve tried, and I can’t find the cost-benefit ratio of testing the entire population over the age of 50 for colon cancer – how many cases of colon cancer are found and treated by colonoscopies that wouldn’t have been found and treated at some point down the road from symptoms? Are we being tested because it’s efficient and effective, or because all the technology is in place and so is there to be used (and often owned by the doctors who order the tests)? Couldn’t there be less complicated (and less expensive) screening tests to determine the degree of propensity to any disease or condition before moving to expensive procedures like colonoscopies? That’s how I’m looking at the next 10 years. If someone in my family is diagnosed with colon cancer, then yes, I’ll have another colonoscopy. If my doctor has good reason to believe, through some more simple screening test, that I might be susceptible to colon cancer, then yes, I’ll have another colonoscopy. But I’m not going to have another colonoscopy just because it’s what everyone over the age of 50 is supposed to do every 10 years. That’s the kind of waste that has made our health care system the most expensive, yet one of the least effective, in the developed world.